Industry-leading healthcare insurance companies rely on the HCFSPlatform™ for Fraud, Waste, Abuse, and Error to deliver millions of dollars in savings, recoveries, and prevented loss each year – a critical component of your companyʼs payment integrity strategy. ...
“Greed was the clear motive," said a health care claims fraud investigator involved with the case. “Patients' needs played no role in ordering tests that were medically unnecessary and could have endangered patient care.” This case was uncovered by a whistleblower, but what about less flagra...
The flagged data is then forwarded to a special investigator for a comprehensive analysis. The fraudulent data is transformed to graphs and charts to illustrate patterns so that the fraud is easily detected and identified.Debra PachaRaul Ariza...
When selecting an external attorney investigator, it’s crucial to ensure they have experience in the healthcare sector due to additional confidentiality requirements, privilege issues, and reporting obligations. Healthcare organizations must comply with stringent standards under the Health Insurance Portabili...
of fraudulent testing. Involved in the investigation are the U.S. attorney’s office in Los Angeles, the FBI, the inspector general’s office of the U.S. Department of Health and Human Services, the state Department of Insurance fraud division and the state Board of Medical Quality Assurance...
related to the business of Parent or any of its Subsidiaries that, at the time such disclosure was made, would reasonably be expected to provide a basis for the FDA to invoke its policy respecting “Fraud, Untrue Statements of Material Facts, Bribery, and Illegal Gratuities” set forth in 56...
Some private health insurers ignore or deny the severity of health care fraud. When I queried a sales manager of a major private insurer about health insurance fraud, he seemed unsure of its magnitude but did not believe it was a serious threat to his industry. Others are aware of the ...
Senior Investigator – Healthcare Fraud Clinical Analyst 4. CVS Health CVS Health is a leading provider of healthcare services and prescriptions, filling over 1 billion prescriptions a year nationwide. Providing online and in-store prescription services, CVS Health offers a wide range of goods and...
Pharmacies purchased HIV medications, a type of insurance fraud Some participants described selling their HIV medications to pharmacies, either currently or in the past, along with the factors that motivated selling and how the process of selling operated. The typical scenario involved pharmacies offerin...
byAdvize Admin|Oct 13, 2020|Fraud,Healthcare,Payers Should a patient who suffers a medical condition as a result of their treatment have to pay for the resulting treatment? Should the financial responsibility go to their insurance or the facility that caused the problem? Before everyone starts ...